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Individual

MS. MARY LYON WEISFELD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
5354 TIMBERLANE RD, LAKE WALES, FL 33898-8959
(276) 973-5683
Mailing address
5354 TIMBERLANE RD, LAKE WALES, FL 33898-8959
(276) 628-5017

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
0001056478
VA
367500000X
Certified Registered Nurse Anesthetist
027870
VA
367500000X
Certified Registered Nurse Anesthetist
38592
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP9389844
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4061629
BLUE CROSS OF TENNESSEE
Enumeration date
01/04/2006
Last updated
11/02/2021
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